Substance Abuse
Substance Abuse
THE SOCIOECONOMIC CAUSES OF SUBSTANCE ABUSE
In the 2000 U.S. census, approximately 4.1 million people reported their race as “American Indian or Alaska Native.” While that constitutes only 1.5 percent of the United States population, the U.S. Department of Health and Human Services reports that American Indians and Alaska Natives account for 2.1 percent of all admissions to publicly funded substance–abuse treatment facilities, with 40 percent of these individuals being referred to such programs by the criminal justice system. This clearly demonstrates that substance abuse continues to be a persistent and growing issue among the Native American population.
NATIVE AMERICANS AND ALCOHOL
Historically, the introduction of intoxicating substances, especially alcohol, among indigenous populations often served the colonial designs of European nations. Alcohol became an important vehicle with which to appropriate resources, weaken the structure of indigenous societies, and destroy indigenous resistance to European colonialism. The overconsumption of alcohol also served to reinforce European beliefs about the inferiority of indigenous peoples, thereby bolstering the belief in “white” racial superiority. As Robert Berkhofer points out in The White Man’s Indian (1979), alcohol abuse provided concrete evidence of Indian degeneracy and criminality, leading to the public stereotype of the “drunken Indian.”
According to Gilbert Quintero, associate professor of anthropology, University of Montana, nonnative beliefs about Indian drunkenness constitute:
A form of colonial knowledge … that creates standardized categories and oppositional differences that distinguish the colonizers from the colonized. In addition, colonial knowledge functions to keep the colonized in a subjugated position relative to the colonizer. It does so primarily by attributing devalued characteristics and features to a specific group of people that is usually recognized as somehow distinct, usually in racial, cultural, or historical terms. (Quintero 2001, p. 57)
Despite the proliferation of scientific research about American Indian drinking, the myth persists that indigenous peoples are predisposed to addiction and that there are biophysical reasons for their inability to control their addictive behaviors. In some respects, the argument that there is a genetic basis to explain excessive alcohol consumption among Native Americans continues to serve the stereotypes of racial inferiority and degeneracy, especially when held up against reported data and beliefs about white alcohol consumption and behaviors. In addition, for some this argument can ostensibly be extended to other forms of substance abuse. There is, in fact, data to establish genetic contributions to alcoholism and other substance abuse addictions. This biogenetic predisposition is not exclusive to Native populations, however, but also exists among all ethnic populations. Evidence specific to American Indian addictions, especially alcohol, reveals that there is more in–group variation than between–group variation, indicating that environmental variables play a significant role in the manifestation of Native substance abuse (May 1994; Mancall 1995). Despite any biogenetic predispositions, however, the amount of substance abuse within a given population, much like the rate of Type II diabetes mellitus, is a reflection of social and economic conditions, not a sign of inferior racial biology. The health status of Native Americans and Alaska Natives, including substance abuse, is directly related to the socioeconomic conditions that exist in indigenous communities. Health levels, therefore, are directly linked to extant social, political, and economic forces.
THE SOCIOECONOMIC CAUSES OF SUBSTANCE ABUSE
Substance abuse and other afflictions are directly related to an array of socioeconomic conditions affecting indigenous communities. According to U.S. 2000 census data, 25.7 percent of American Indians and Alaska Natives live in poverty—twice the national average. Among selected tribes, poverty rates range from 18 percent to 38.9 percent. Paralleling poverty rates, the labor–force participation rate for American Indians and Alaska Natives is lower than among the general U.S. population. In addition, earnings
among full–time, year–round Native workers are substantially lower than the earnings of all U.S. workers. This is particularly true for indigenous men, who also experience higher unemployment and underemployment rates.
Level of education is clearly associated with labor–force participation and earnings. According to the Census Bureau, “the educational levels of American Indians and Alaska Natives were below those of the total population in 2000.” In particular, 71 percent “had at least a high school education, compared with 80 percent of the total population” (U.S. Census Bureau 2006). As a result of this educational disparity the distribution of employment for Native peoples is heavily concentrated in the nonmanagerial positions and professions, clustering them in a particular class and economic sector.
American Indians and Alaska Natives have a higher percentage of single–parent homes than the total population. According to Census 2000, slightly more than 28 percent of Native households are single–parent homes, compared to 15.5 percent of total U.S. households. The vast majority of these households are headed by a woman with no husband present (20.7% of Native households). This percentage increases by 4.1 percent if the household is located on reservation lands, trust lands, or other tribally designated lands. Moreover, the average household size is 22.6 percent larger on tribally designated lands than among the total U.S. population.
It is estimated that Native Americans have six times the number of substandard homes as the rest of the United States. Many homes do not have water or adequate sewage systems. More than 30 percent of low–income American Indians live in overcrowded homes, as there is at least a 200,000 unit housing shortage across Indian country. Moreover, the construction of cluster housing on many reservations has created a particular type of residential segregation that contributes to elevated risks of violence, substance abuse, and other community health problems.
Finally, no other U.S. ethnic group has the lives of its people, including their health care, so heavily dictated by federal laws, policies, and treaties. As early as 1820, Western medical services became an integral component of U.S. Indian policy. As of 2007, the Indian Health Service (IHS), located within the Department of Health and Human Services, administers primary and preventive care to eligible Native peoples within their established service areas. The IHS largely operates on annual congressional appropriations, but the per capita expenditure for indigenous patients is only 61.3 percent of the per capita personal healthcare expenditures for the total U.S. population. This results in a rationing of health care, an inequitable distribution of healthcare resources, and limited primary treatment and prevention services. The U.S. Congress Office of Technology Assessment reports that these disparities pose significant risks for the development of health problems, particularly behavioral health issues such as substance abuse.
THE IMPACT OF SUBSTANCE ABUSE
Substance abuse mortality rates continue to exceed the rates for the general U.S. population. In 1995, the age–adjusted drug–related death rate for American Indians and Alaskan Natives was 65 percent higher than for the total population. In addition, the National Institute of Drug Abuse (NIDA) reported in 2003 that American Indians and Alaska Natives exhibit the highest estimated prevalence of past–month tobacco smoking and heavy alcohol consumption of any recognized racial/ethnic minority population. Age–adjusted lung cancer rates among this population increased 184 percent between 1973 and 2006.
Between 1985 and 2000, age–adjusted alcohol death rates among the Native population increased 28 percent, seven times the rate for the total population. The IHS reported in 1998–1999 that first diagnosis of alcoholic psychosis, alcoholism, alcohol–related chronic liver disease, and cirrhosis was 1.6 times higher in IHS and tribal hospitals than in U.S. general short–stay hospitals.
In addition to alcohol and cigarette abuse, illicit drug use and nonmedical prescription drug abuse is also becoming a plague among American Indian and Alaskan Native communities. A 2003 NIDA survey measuring prevalence of past–month drug use revealed that indigenous peoples consume illicit drugs, marijuana, and cocaine at significantly higher rates than any other racial/ethnic population. This data is corroborated by the 2003 National Household Survey on Drug Abuse Report, which recorded that American Indians or Alaska Natives aged twelve or older had a higher rate of past–year substance dependence or abuse than any other racial/ethnic population.
Mortality attributed to drug use is also increasing at a steady pace among Native peoples. Drug–related death rates for this population increased 164 percent between 1979 and 1998, when it was 1.8 times higher the U.S. all–races rate. Within the Native population, there is a large disparity in drug–related deaths between males and females. For the 1996–1998 period, the peak male age–specific drug–related death rate was 111 percent higher than the peak female rate, according to the IHS’s report Trends in Indian Health, 2000–2001.
Methamphetamine (meth) abuse is causing havoc among Native Americans and Alaska Native communities. According to IHS data, the number of recorded patient services related to meth use rose 2.5 times from 2000 until 2005. Robert McSwain, the deputy director of the IHS reported to Congress in 2006 that the age cohort most affected by the use of this drug is age 15 to age 44. The social effects of methamphetamine addiction reach beyond the individual user. Addicted parents neglect their children, leading to child abuse, a rise in child placements, and more broken homes. The use and selling of this drug also fuels increases in homicides, aggravated assaults, rape, domestic violence, and possibly suicides. Statistics from a southwestern reservation indicate the extent of the crisis. In 2004 there were 101 suicide attempts on the reservation, with eight out of ten involving methamphetamine. That same year, 64 out of 256 babies born on the reservation were born to addicted mothers. Kathleen Kitcheyan, the chairwoman of the San Carlos Apache Tribe, has testified that of the child neglect and abuse cases reported in 2005 to Tribal Child Protective Services, 80 percent involved illicit drug use, alcohol use, or both.
Methamphetamine also is straining tribal law enforcement, health–care resources, and funding for tribal housing. For example, it is estimated that the elimination of hazardous material from a home used as a meth laboratory can cost $10,000. With IHS and tribal health programs funded at less than 60 percent of the level necessary to meet adequate levels of care, methamphetamine abuse is crippling an already overtaxed healthcare system.
SUBSTANCE ABUSE AND CRIME
There is an intimate and growing relationship between violent crimes and substance abuse. In 2004, the U.S. Department of Justice reported that American Indians experience a per capita rate of violence twice that of the U.S. resident population, with an average of one violent crime per ten residents aged twelve or older. Seventy–five percent of all investigations in Indian country by the Federal Justice system involve violent crimes. Significantly, indigenous victims of violence report that 62 percent of offenders were under the influence of alcohol at the time of the attack, with drugs being involved about 9 percent of the time. Fourteen percent of victims report that the offender was using both alcohol and drugs.
Similar to the introduction of alcohol centuries ago, methamphetamine is being injected into native communities by non–native drug cartels. On a Great Plains reservation, for example, a Mexican meth cartel attempted to introduce the drug to the reservation. In an Oklahoma Native community, the Satan’s Disciples, a violent Chicago street gang, organized a methamphetamine trafficking operation targeting indigenous peoples.
Paralleling the rise in drug use and drug trafficking is a rise in youth gang activities. The onset of gang activity is associated with a variety of factors, including the frequency with which families move off and onto the reservation; poverty, substance abuse, and family dysfunction; the development of reservation cluster housing; and a waning connection to tribal cultural traditions. According to a 2004 report titled “Youth Gangs in Indian Country,” drug sales account for 22 percent of criminal offenses by gang members, with aggravated assault accounting for 15 percent of offenses. Communities surveyed cited substance abuse, particularly alcohol (96%) and drugs (88%), as a significant problem contributing to antisocial behavior among youth and adults.
As a result of high levels of substance abuse, many racial minorities, including Native Americans, are disproportionately imprisoned for numerous offenses. According to data for 1999–2000, American Indians and Alaska Natives are incarcerated at a higher rate than any other racial/ethnic minority, except African Americans. Despite being the smallest racial/ethnic population, more than 4 percent of Native peoples are under correctional supervision, and this percentage is rising, due in large part to an increase in different forms of illicit substance abuse. The 2001 alcohol–related arrest rate for the American Indian and Alaska Native population was higher than the rate for all races.
Indigenous peoples experience significantly higher rates of violent crime. Between 1992 and 2002, “among American Indians age 25 to 34, the rate of violent crime victimizations was more than 2½ times the rate for all persons the same age” (U.S. Department of Justice 2004). In 2001, 54.9 percent of American Indians entering the federal prison system had been convicted of violent crimes, while only 4.1 percent of whites and 13.3 percent of African Americans in prison had committed violent crimes. The Justice Department notes, however, that “approximately 60% of American Indian victims of violence, about the same percentage as of all victims of violence, described the offender as white” (U.S. Department of Justice 2004). Arrests for drug offenses accounted for 12.1 percent of American Indians entering the prison system.
Substance abuse, like other health challenges faced by American Indian and Native Alaska communities, is rooted in political economic conditions. Social and economic conditions that are prevalent in many indigenous communities provide fertile ground not only for the initiation of substance abuse, but also for its perpetuation. Substance abuse is only one component of the larger spectrum of health disparities that reflect race and class. Native peoples share the same racial and class landscape as other racial minorities and poor people.
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Gregory R. Campbell